Demographic shifts in recent years have made New Hampshire the second-oldest state in the nation, which means a higher demand for senior care services provided by places like Visiting Angels and Right at Home, which specialize in in-home care and have plans to grow in the coming months.

Rich and Janet Sullivan started a Right at Home franchise in New Hampshire in 2008. The Sullivans had hired an in-home caregiver for Rich Sullivan’s mother and say the experience had a remarkable effect on her well-being and quality of life. She had Alzheimer’s disease, and the Sullivans saw her go from nonresponsive to engaging with family and having fun at the beach in the span of a week.

“We realized and experienced firsthand the benefits of home care for her,” Janet Sullivan said.

When they started their company, they had about a dozen caregivers and a scheduler in the office, based in the Londonderry area. Now, they have upward of 100 employees and plan to have about 200 as they expand into the Seacoast area with a new office in Portsmouth.

Visiting Angels services communities across southern New Hampshire, from Salem to Concord and in the Seacoast. Its owner, Debra Desrosiers, said they are opening a new branch in Gilford this fall that will extend services as far north as Plymouth.

Janet Sullivan said there are a lot of seniors who thrive in a home environment and don’t want to leave it for an assisted living facility.

“What we’re really talking about here is a large group of seniors in southern New Hampshire, many of whom want to just remain at home,” she said. “Whether it’s help around the house, or if it’s after a hospital or rehab stay, they want to stay in familiar surroundings.”

Siobhan Nolan, a registered nurse and care coordinator at Catholic Medical Center in Manchester, said she sees a lot of elderly patients responding positively to in-home care. The Visiting Nurse Association can provide a lot of medical care in the home, she said. But she said nonmedical caregivers can also make a big difference when it comes to day-to-day things like stocking food or cleaning the house.

“A lot of times, social issues come to light that we wouldn’t be privy to … unless we were physically there,” Nolan said.

And when things go wrong, caregivers can report them to the hospital.

“They’re a lifeline,” Nolan said.

And Desrosiers said elders often respond positively to the simple social interaction.

“The socialization is very important, I think, because they’re isolated in their homes,” Desrosiers said.

Studies, too, have shown staying at home has many benefits.

“What starts out as a stranger coming into your house can oftentimes develop into a very strong relationship in terms of quality of life,” Janet Sullivan said.

The care provided by Right at Home is customized for each person. Sometimes people return home after long hospital stays for weeks and months and all their food and medications have expired. Meanwhile, they aren’t able to easily get around to shop for more food or renew prescriptions and often grow ill from malnourishment, dehydration or lack of medication and end up right back in the hospital.

A study by Right at Home corporate looked at hospital readmissions in North Carolina and found that the average readmission cost for a hospital was $7,200 per patient. But a home-care package that helped discharged patients at home for a period of time reduced readmissions by 62 percent while only costing an average of $295.

As a result, some hospitals opted to cover the cost of a post-discharge home-care package.

But right now, in-home care is mostly paid for through private payer insurance or out of pocket.

Caregivers through Right at Home in New Hampshire are paid per diem and patients are charged an hourly rate with a minimum of three hours.

“The range can go from $23.50 an hour to $26.50,” Rich Sullivan said. Desrosiers said Visiting Angels charges between $25 and $27 an hour.

Most of the employees at Right at Home are Licensed Nursing Assistants, though the care they provide is mostly non-medical. There is a lead nurse employed by the company, which helps provide some medical oversight to catch problems early. It also helps nurses in training get certified by working with the nurse.

Part of the challenge is the high bar prospective caregivers must meet. Right at Home screens employees far beyond what’s required by the state with 12-panel drug testing, lift tests and background checks in other states where they lived.

Having the right staff, though, is critical. Seniors often have 24/7 caregivers with them, according to Rich Sullivan, and the caregivers will often go with the seniors to hospitals or other facilities to supplement the care they receive.

“A hospital stay or rehab stay is traumatic for an elderly person. So if they have the consistency of their caregiver with them, it makes a huge difference in their ability to recover and get back home,” Rich Sullivan said.